Acute hepatic injury after the withdrawal of immunosuppressive chemotherapy in patients with hepatitis B.
Five patients with lymphoproliferative malignancies and chronic hepatitis B suffered severe acute hepatic injury after the withdrawal of multiagent chemotherapy that included high-dose corticosteroid. Four patients died of hepatic failure, three of whom received corticosteroid as treatment for the hepatic injury. We believe that the cause of this entity is massive immune-associated cytolysis of hepatitis B virus infected hepatocytes occurring after a period of immunosuppression and increased viral replication. The literature regarding this complication of chemotherapy and its pathophysiology is reviewed.
Pinto
P C
PC
Department of Medicine, Los Angeles County University of Southern California Medical Center.
Hu
E
E
Bernstein-Singer
M
M
Pinter-Brown
L
L
Govindarajan
S
S
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000201:enzymology / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology; D008099:Liver / Q000187:drug effects*; D008111:Liver Function Tests; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use
D006514:Hepatitis B Surface Antigens; D011241:Prednisone